Working with children and young people who have displayed harmful sexual behaviour: evidence based guidance for professionals working with children and young people

B) Inappropriate and problematic sexual behaviour

Example 1 (inappropriate behaviour):

Leo and Mark, both aged 15 years, were found by a teacher kissing and masturbating each other in a changing room at school. The behaviour was consensual and reciprocal.

Although a socially acceptable behaviour and within normative developmental parameters, the behaviour took place in a public space and is inappropriate. The boys were given advice sexual activities. Tommy’s family put in place clear boundaries, supervision and monitoring around the use of his phone and his online activity. As Tommy was quite isolated with few friendships and limited social skills, a plan was put in place to gradually build these up within the school environment. Tommy previously had quite fixed interests in certain hobbies and liked strict routines. Taking all these factors into account, it was agreed that it would be helpful to request a neurodevelopmental assessment. His parents contacted their GP, who made a referral to Child and Adolescent Mental Health Services (CAMHS) for this assessment. about healthy sexual relationships, the law in relation to underage sexual activity and the importance of ensuring that sexual behaviours take place in private. They were encouraged to come back and have more discussion if further advice and guidance or emotional support would be helpful.

Example 2 (problematic behaviour):

Over a period of 3 weeks Tommy, age 13 years, sent messages from his phone asking numerous girls to send him pictures of themselves naked. He only knows these girls through social media and believes they are the same age as him. The messages do not contain any threats and he has not followed up the request when told to desist by some of the girls. This behaviour is developmentally unusual, is a repeated pattern and shows some indications of compulsivity. Although there is no overt use of coercion, force or abuse of power there are clear concerns about Tommy’s understanding of consent, the use of images should any have been shared, and the illegal nature of sharing such images. A child’s planning meeting which included his guidance teacher, his parents and a representative from social work was held to discuss Tommy’s problematic sexual behaviour. Support was offered to the girls messaged by Tommy. It was agreed that some intensive education work would be undertaken with Tommy and his family about healthy sexual relationships, consent, and legal and illegal

Inappropriate and problematic behaviours tend to be sexual behaviours that do not lead to victimisation but may be developmentally harmful at the time or if they persist. Typically key adults involved will be parents/ carers, school, and in some circumstances CAMHS, Youth Work, Third sector organisations and social work.

Inappropriate and problematic behaviour can cover a broad range of behaviours. At the lowest level responses may require boundary setting and single agency responses, with children being gently redirected to alternative activities depending on age, and the behaviour used as an opportunity to engage them in discussion on healthy sexual expression and behaviour in an age appropriate way. House, family and community rules and expectations of behaviour should be reinforced as needed to ensure children understand appropriate behaviour. Monitoring of the behaviour to ensure it does not continue and/ or escalate may be needed.

Some problematic behaviour may require a Child’s Plan and a multi-agency response led by a Lead Professional with system changes to promote safety and behaviour management. Social work will typically be involved in some capacity in such cases.

Initial assessment

Where initial screening using the Hackett continuum and traffic light tools determines that a child’s sexual behaviours are ‘inappropriate’ or ‘problematic’, an assessment is warranted. This should consider first and foremost any child protection concerns for all children involved, and whether there are any concerns about where a child may have learnt or been exposed to certain sexual behaviours. It is important to take account of the child or young person’s age, developmental status and sex and, if relevant, any neurodevelopmental or learning disabilities. Inappropriate and problematic sexualised behaviour is often an expression of a range of problems or underlying vulnerabilities.

If the incident suggests that any of the children involved (including the child causing harm) may have been abused or neglected and/ or is suffering or are likely to suffer significant harm, contact should be made with police or social work in order for an inter-agency referral discussion (IRD) to be considered as soon as reasonably practicable. This meeting will consider immediate safety of all children involved, and any action that may be required in order to investigate possible abuse.

The assessment should be individualised, developmentally appropriate, proportionate to the behaviour of concern and take into account the context within which the behaviour took place. In such circumstances, a detailed or lengthy assessment focused on the sexual behaviour is likely to be stigmatising, resulting in unavoidable upset for the child and their family and is unlikely to lead to positive outcomes. In CAMHS contexts, screening tools such as the Child Sexual Behaviour Inventory may be used if the child is under the age of 12 to aid clinical judgement.

The purpose of the assessment is to identify whether the child or young person has unmet needs that can be met by universal services in line with the GIRFEC approach. The principle tools to be used are traffic light tools, the Hackett continuum and the GIRFEC national practice model. The assessment should be undertaken by a lead professional who supports the child and family, acts as an advocate on their behalf, and coordinates the Child’s Plan and delivery of appropriate additional services. The decision on who should lead should be made on a case-by- case basis, with input from the child or young person and their family. It could be a professional from health, education or social work.

Ensuring that the assessment is rights respecting is crucial. Whilst it is important that the child can express their views and have them considered and taken seriously, this needs to be proportionate to the behaviour of concern and should also take account of their right to privacy. Consideration should therefore be given to whether the information already available is sufficient, and whether speaking to the child would be duplication and potentially upsetting for them. If there is a need to discuss the behaviour with the child further for the purpose of the assessment, then consideration should be given to who is the most appropriate person to do this but also who the child would be most comfortable discussing this with given the sensitive nature of sexual behaviours. Clearly involvement of any individuals and the sharing of information would need to be proportionate.

If the assessment reveals that the behaviour is abusive rather than inappropriate or problematic, the following section on sexually abusive and violent behaviour (page 26) should be consulted.

Interventions

Approaches to intervention tend to focus on behaviour management, socio-educative work with the child/ family and system/ context change.

Depending on the outcome of the assessment, responses to inappropriate or problematic sexual behaviours can be wide ranging from low level interventions such as clear boundary setting, to more in depth supports such as education about healthy relationships, skills development, behaviour management and monitoring. For some this may include particular support around issues such as intrusive thinking or compulsive use of online pornography. Wider system changes may also be required depending upon the context within which the behaviour occurred. For example, responses may be needed to address the attitudes or cultures within certain groups or improve safety in certain areas including online spaces. Low- level problematic sexual behaviour involving pre-adolescent children may be identified in Early Learning and Childcare settings and primary schools as well as in home settings. They should be responded to in line with other challenging behaviour, requiring adults to be specific about naming and describing the behaviour, pointing out to the child the impact on others, setting clear boundaries and developing individualised strategies to reduce the likelihood of repetition. Adults need to explain to the child why the behaviour is inappropriate in a way that does not increase shame, setting boundaries, encouraging strategies around self-control and positive emotional expression, and establishing a plan to increase safety, are often measures sufficient to modify behaviour.

When assessing the nature of the inappropriate or problematic harmful sexual behaviour it is important to consider what needs the behaviour was meeting for the child. Sexual behaviour can be used to meet a range of needs, including wider wellbeing needs. In practice example 2 above, for instance, Tommy’s appropriate needs for intimacy and connection with others as well as age appropriate sexual curiosity have been expressed in ways that cause harm to others by engendering distress and upset.

In terms of responsibilities, school staff will typically focus on RSHP education. Class or group work and targeted one to one support may be provided as required and they may put in place a Child’s Plan. They may work with parents on monitoring behaviour, setting boundaries, rewards and consequences.

Parents’ responsibility will involve replicating RSHP work at home and working with the school on boundaries, rewards and consequences.

Social work may support the child and family. Identifying and supporting with contributory factors e.g. parenting, sleep, leisure activities, relationships, friendships, relaxation, use of technology and safety planning where appropriate. CAMHS may have a role if the behaviour links to mental health or issues around learning impairment or neurodiversity.